TB in children: Overlooked, undiagnosed and underestimated — continued neglect adds up to lost lives, missed opportunities

Two years ago, a Comment in Lancet‘s 2014 Tuberculosis edition points out, World TB Day focused on childhood tuberculosis, with good reason. When correctly diagnosed, children with multi-drug resistant TB have better odds of being cured than adults. Effective efforts to screen and diagnose children also can serve as sentinel surveillance, leading to better tuberculosis control in communities, homes, schools. They comprise more than a quarter of the world’s population — 40 percent of the population in the world’s poorest countries — and yet, where counting their numbers would have an important impact on public health, they go uncounted. How uncounted is the subject of findings released in the same Lancet edition, indicating that nearly a million children get sick with tuberculosis on a yearly basis — not only three times the number who are correctly diagnosed, but twice the previous estimate. While nearly 32,000 of those children, according to the findings, have disease that is resistant to multiple treatments, no previous estimate of drug-resistant tuberculosis among children existed.

The difference between the authors’ findings and World Health Organization data showing roughly 500,000 children contracting tuberculosis in a year stems from a different approach, the article notes, acknowledging the obstacles to correctly diagnosing children. Those obstacles to correct estimates of tuberculosis incidence in children have long been noted, and included that children can’t produce enough sputum to lead to accurate diagnoses by the most common methods. In addition, children are likelier to be sickened by smaller numbers of bacteria. But, the authors found, past data have indicated that their exposure and subsequent illnesses are proportionate to that of adults in their settings.

The authors conclude that the unmet need for treatment among children with tuberculosis and with multidrug-resistant tuberculosis is vast, for “the former previously underestimated and the latter heretofore unknown. Continued failure to meet those needs will lead to large numbers of continued unecessary deaths, they note. At the same time, improved case detection will lead to better planning for resources, in turn leading to more effective future efforts. The Comment piece, noted above, includes a chart of previous progress in childhood tuberculosis responses, and ongoing challenges.